NPIMap

Individual provider Active NPI

Richard Kenneth Clark, PA-C

  • Physician Assistant
  • Rhinelander, WI
National Provider Identifier
1235580903
Registry record updated Jun 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3766-23 Issued in WI
Practice address
1630 Chippewa Dr
Rhinelander, WI 54501-9503
Phone
(715) 361-5480
NPI assigned
Jun 23, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3766-23 WI Primary

Addresses

Primary practice location

1630 Chippewa Dr
Rhinelander, WI 54501-9503

Mailing address

PO Box 646
Woodruff, WI 54568-0646
Phone (715) 614-0038

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160804002689 WI Practitioner - Physician Assistant 1153615711 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Minnesota Medical School, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1630 Chippewa Dr
Rhinelander, WI 54501-9503
Phone (715) 361-5480

2251 N Shore Dr
Rhinelander, WI 54501-6710
Phone (715) 361-2000

240 Maple St
Woodruff, WI 54568-9190
Phone (715) 356-8140

Hospital & facility affiliations

  • Aspirus at Home Home health agency, Wausau, WI, CCN 527016
  • Compassus Home Health Home health agency, Rhinelander, WI, CCN 527218
  • Aspirus at Home Hospice, Wausau, WI, CCN 521624
  • Aspirus Rhinelander Hospital Hospital, Rhinelander, WI, CCN 520019
  • Aspirus Eagle River Hospital Hospital, Eagle River, WI, CCN 521300
  • Aspirus Tomahawk Hospital Hospital, Tomahawk, WI, CCN 521313
  • Langlade Hospital Hospital, Antigo, WI, CCN 521350
  • Aspirus Wausau Hospital Hospital, Wausau, WI, CCN 520030

Merit-based Incentive Payment System (MIPS)

Final score
87.84 of 100Reported as group
Quality
86.21
Promoting interoperability
100
Improvement activities
40
Cost
73.25

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3766-23WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Medical Group, Inc. CurrentSince Jul 1, 2016 Accepting new patients
The Howard Young Medical Center, Inc. CurrentSince Jun 7, 2022 Accepting new patients
Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. CurrentSince Dec 1, 2021 Accepting new patients
Aspirus Medical Group, Inc. CurrentSince Jul 1, 2016 Accepting new patients
Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. CurrentSince Dec 1, 2021 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

1630 N Chippewa Dr
Rhinelander, WI 54501
Phone (715) 361-5480

2251 N Shore Dr
Ste 100
Rhinelander, WI 54501
Phone (715) 361-2074

4005 Community Center Dr
Weston, WI 54476
Phone (715) 241-5400

240 Maple St
Woodruff, WI 54568
Phone (715) 356-8000

Interoperability endpoints

  • Direct secure messaging: rclark113473@direct.aspirus.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 35

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 35

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466640000000",
    "number": "1235580903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 646",
            "city": "WOODRUFF",
            "state": "WI",
            "postal_code": "545680646",
            "telephone_number": "715-614-0038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 CHIPPEWA DR",
            "city": "RHINELANDER",
            "state": "WI",
            "postal_code": "545019503",
            "telephone_number": "715-361-5480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "RICHARD",
        "middle_name": "KENNETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-23",
        "last_updated": "2016-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3766-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rhinelander, WI

Sources for this page

Verify at the official NPI Registry.